Download (vatp) on knowledge regarding high risk pregnancy among

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
BANGALORE, KARNATAKA
ANNEXURE-II
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1.
Name of the candidate and address
ASHWINI KAMATH
1ST YEAR M.SC. NURSING
ST. ANN’S COLLEGE OF NURSING, MULKI
MANGALORE-574154.
2.
Name of the institution
ST. ANN’S COLLEGE OF NURSING, MULKI
MANGALORE-574154.
3.
Course of study and subject
M.SC. NURSING
OBSTETRICS AND GYNAECOLOGYCAL
NURSING.
4
Date of admission to course
5
Title of the topic:
25.07.11
EFFECTIVENESS OF VIDEO ASSISTED TEACHING PROGRAM
(VATP) ON KNOWLEDGE REGARDING HIGH RISK PREGNANCY
AMONG PRIMIGRAVID WOMEN ATTENDING ANTE-NATAL
CLINIC IN A SELECTED HOSPITAL UDUPI.
6
BRIEF RESUME OF THE INTENDED WORK
6.1
The need for the study
The test of any civilization is the measure of consideration which it gives to its
weaker members. A women has two smiles that an angle might envy, the smile that
aspects a lower before words are uttered, and the smile that lights on the first born
babe, and assures it of a mother’s love.1
Pregnancy and child birth is one of life’s major events. It is joyous and
rewarding as the woman passes through a transitional phase, into a new life of
motherhood. Each pregnancy that a woman experiences will be new and different. The
midwife is in a unique position to educate and empower women through the phases of
childbirth, in order for them achieve a healthy pregnancy with the optimum outcome
of the healthy baby.2
During pregnancy a woman’s body undergoes complex physiological changes
of such magnitude, that many are still not well understood. Every system in a woman’s
body adapts to the demand of the growing fetus. A great deal of attention during
pregnancy is focused on ensuring minimum risk at delivery and maximum health of
the woman and her fetus. Antenatal care aims at giving specific attention to the health
needs of a woman and her unborn child. However, a mother may need instructions
about exactly what constitute a healthy lifestyle for herself and her baby.3
Pregnancy may be complicated by a variety of disorders and conditions that
can profoundly affect the woman and her fetus. When these unexpected deviations or
complications from the normal pregnancy occur, it can place severe burden on a
woman and her family.4 Regular antenatal checkups beginning early in pregnancy
undoubtedly prevent many ensuring problems. It contributes to timely diagnosis and
treatment and enables women to form relationship with midwives, obstetricians and
other health professionals who become involved with them in striving to achieve the
best possible pregnancy outcomes.2 All pregnant women by virtues of their pregnant
status face some level of maternal risk. Data suggest that around 40% of all pregnant
women have some complications. About 15% of pregnant women need obstetric care
to manage complications, which is potentially life threatening to mother or infant.5
Despite impressive gains in safety in recent decades, pregnancy remains risky
business. From early in pregnancy until some weeks after its conclusion, pregnant
women are at increased risk of morbidity and mortality compared with women are not
pregnant. According to US centres of disease control and prevention including vital
statistics from the National Centre for Health Statistics, the 3 leading causes of
maternal death today are pregnancy induced hypertension, haemorrhage and anaemia.
Although comprehensive data on pregnancy, about 22% of all pregnant women are
hospitalized before delivery because of risk factors.6
According to the global impact of pre eclampsia and eclampsia, the 10% of
women have high blood pressure during pregnancy, and pre eclampsia complicates 2%
to 8% of pregnancies overall, 10% to15% of direct maternal deaths are associated with
preeclampsia and eclampsia. Hypertensive disorders in pregnancy are responsible for
76000 maternal and 500000 infants deaths each year worldwide. According to World
Health Organization(2005), 35% of maternal deaths are due to hypertensive disorders
in pregnancy.7
A cross-sectional study was carried out on a sample of 900 pregnant women
attending MCH centres in Alexandria to determine the incidence of high risk
pregnancy and to demonstrate the common risk factors among them. Data was
analysed between June to August in 1989. Morrison and Olsen (1979) scoring system
was used and it was between 0-14. Mothers with scores 0-2 were considered at low
risk those with score 3 and more were categorised as high risk. Results revealed that
high risk women constituted 27.78% of the sample. The most frequently encountered
were anaemia (37.33%), age 35+ (15.66%), parity 5+ (16.66%), previous
gynaecological surgery (8.88%) and history of previous stillbirth or neonatal death
(6.11%). The mean number of risk factors in the low risk group was 0.95 compared to
3.03 in the high risk group. It is suggested that health workers should also learn how to
identify and manage high risk pregnancies, it helps to make the early antenatal
diagnosis and determine the care.8
A prospective cohort study was conducted in Netherlands to identify the
perinatal mortality and severe morbidity in low and high risk term pregnancies. The
data was collected from a national perinatal register, total 37735 normally formed
infants were delivered at 37 weeks of gestation. Sixty antepartum stillbirths (1.59 per
1000) babies delivered, 22 intrapartum stillbirths (0.58per 1000) babies delivered, and
210 NICU admissions (5.58per 1000live births) occurred, of which 17 neonates died
(0.45per 1000 live births). The overall perinatal death rate was (2.62 per 1000 babies)
and was significantly higher for nulliparous women compared with multiparous
women. The findings have shown that infants of pregnant women at low risk who
delivered in primary care under the supervision of midwife compare to whose labour
started in secondary care under the supervision of an obstetrician. It is suggested that
women can be supervised by a midwife can deliver at home or hospital and the second
group who needs the secondary care by an obstetrician.10
India accounts for about one quarter of maternal deaths worldwide, with the
most recent statistics showing an average maternal mortality ratio of 407 per 100000
live births at the national level. The government had hopes to reduce maternal
mortality to 200 by 2000, but it is clear that this was not achieved. The equipment and
technical competence to provides service is weak at the present moment. Reductions in
maternal mortality would require interventions to improve service delivery as well as
community mobilization to improve utilization of services, especially in life
threatening situations. More women die in India during child birth than anywhere else.
In the world of the 5.36 lakhs women who died during pregnancy or after child birth in
2005 globally, India accounted for 1.17lakhs. This is followed by Nigeria 58000,
Congo 32000, and Afganistan 26000, India along with other countries, accounted for
almost 65 percent of global maternal health in 2005.9
High risk pregnancy is one which is complicated by factor or factors that
adversely the pregnancy outcome maternal or perinatal or both.11 Safe motherhood is
the right of all women. To create awareness about this is a fundamental right of
women. Maternal death is an avoidable tragedy. A little bit of care and awareness can
go long way in preventing this tragedy. To let go of a human life, as precious as that of
a mother, is a real shame. So let us pledge to stop this needless loss of precious life.12
From the above identified finding it is obvious that, necessary to educate the
primigravid women regarding high risk pregnancy and its remedial measures. The
investigator during her clinical posting and interaction with primigravid women
observed that they lack knowledge regarding high risk pregnancy, hence it seemed
logical to provide some knowledge regarding high risk pregnancy and child care, so
that the mothers become more aware themselves. Therefore the investigator felt the
necessity to impart knowledge to the primigravid women regarding high risk
pregnancy with the help of video assisted teaching program.
6.2
Review literature
A survey was conducted at Lahore from January to December 2003 to find
out the prevalence and outcome of high risk pregnancies. Data was collected by house
to house survey, followed by registration of families for service and follow up. Total
families were 1225 with a total population of 10226 and 226 pregnancies delivered
during study period. Pregnancies labelled as high risk on the basis of age, education,
gravidity, obstetric history and medical history. High risk pregnancies were 69.5% as
compared to 30.5% of low risk category and 73.24% of females with high risk
pregnancy were illiterate as compared to 62.31% with low risk pregnancy. Literate
women were 26.75% in high risk pregnancies and 37.68% in low risk. Results showed
that prevalence of high risk pregnancies in the community was 69.46%.Therefore
education probably helps the women to understand the motivational efforts of the
health professional for safe motherhood.13
A study was conducted on 400 women attending the outpatient department or
admitted for safe delivery in maternity hospital of Kashmir over a period of two years
(2003-05) to find out the high risk pregnancy by a scoring system and its correlation
with perinatal outcome. Samples were randomly selected in their third trimester, which
were categorized on the basis of a simple scoring system into no risk, moderate risk
and high risk pregnancies. The results have shown that maternal risk scores correlated
well with birth weight, gestational age, 5 min Apgar and perinatal survival. It seems to
categorising mothers into risk groups using a simple scoring system, is a simple and
cost effective method to predict perinatal outcome and to reduce perinatal morbidity
and mortality.14
A cross sectional survey was done to evaluate the knowledge of mothers
regarding pre and post-natal preventive care in the Tunisian region. Total 915 pregnant
women were selected. Based on a questionnaire various aspects of preventive care for
women was carried out. The majority of women, i.e. 95% were aware of the number of
prenatal visits, but 12% did not have any knowledge of the recommended number of
prenatal visits, contraceptive uses, tetanus vaccination and post-natal consultation.
This study concluded that health education on preventive care reviewed by the mothers
helps increase knowledge and practices as well. The increase in mothers knowledge
happens with appropriate initial and continued health education provided by health
professionals and with the reinforcement of educational activities, during each contact
with the mother both in her pregnancy and in periods when she is not pregnant.16
A longitudinal study was conducted in Miraj to identify the prevalence of
anaemia in pregnancy in semi urban area. Altogether 360 women viz. 220 pregnant
and 140 non-pregnant women were studied in relation to attributes like nutritional
intake, anthropometry, economic and socio-cultural factors. Considering WHO’s
criteria for labelling anaemia, women the present study revealed that the prevalence of
anaemia is significantly high in both groups, i.e. 68.18% in study group and 49.28% in
control groups. This high prevalence may be due to the burden of pregnancy which
increases demand for all haemopoietic nutrients which is already ignored during nonpregnant state and thereby pregnancy aggravates already existing deficiency. In view
of this, antenatal clinics have contribution to improve health status of mother and
child, not only in the form of service component but stress on relevant health
education.15
The above studies revealed that maternal mortality and morbidity continued
to be an area of concern across the globe despite the advances in various sectors such
as science, technology, industry and so on. Primary preventive, interventional
strategies should be undertaken to bring about a reduction in perinatal mortality and
morbidity. Health education interventions are widely seen as the most appropriate
strategy for promoting maternal health. Assessing of the existing knowledge will help
to understand the area of need and provide a basis for planning the education program.
6.3
Statement of the problem
Effectiveness of video assisted teaching program (VATP) on knowledge
regarding high risk pregnancy among primigravid women attending ante-natal clinic in
a selected hospital udupi.
6.4
Objectives of the study
6.4.1
To determine the level of knowledge on high risk pregnancy among
primigravid women, measured using structured interview schedule.
6.4.2
To find the effectiveness of video assisted teaching program (VATP) on
Knowledge regarding high risk pregnancy among primigravid women in
terms of gain in knowledge score.
6.4.3
To find the association of pre-test knowledge scores with selected baseline
characteristics such as age, education, occupation and area of living.
6.5
Operational definitions
6.5.1
Effectiveness: In this study it refers to the extent to which the video assisted
Teaching program has achieved the intended results in terms of gain in
knowledge score, measured using structured interview schedule.
6.5.2
Video assisted teaching program: In this study video assisted teaching
program refers to the systematically designed teaching program by the
investigator on selected aspects of high risk pregnancy such as meaning,
causes, clinical features, prevention, and management with video clipping for
the primigravid women.
6.5.3
Knowledge regarding high risk pregnancy: In this study knowledge
regarding high risk pregnancy refers to the extent of information, primigravid
women has in terms of knowledge scores on selected aspects (gestational
diabetes, preeclampsia, and anaemia) of high risk pregnancy as measured
using interview schedule.
6.5.4
Primigravid women: In this study primigravid women refers to a woman
who is pregnant for the first time and within 20 weeks of gestation attending
ante-natal clinic in a selected hospital udupi.
6.6
Assumptions
The study assumes that
6.6.1
Primigravid women may have some knowledge regarding high risk
pregnancy.
6.6.2
Knowledge on high risk pregnancy helps to reduce maternal, perinatal and
neonatal morbidity and mortality.
6.7
Delimitations
Study is delimited to
6.7.1
Primigravid women within 20 weeks of gestation who visit the outpatient
department for antenatal examination in a selected hospital udupi.
6.8
Hypotheses
The following hypotheses will be tested at 0.05 level of significance
6.8.1
H1: There will be significant difference between the mean pre-test and
post-test knowledge scores on high risk pregnancy among primigravid
women attending ante-natal clinic in a selected hospital, udupi.
6.8.2
H2 : There will be significant association of pretest knowledge scores with
selected baseline characteristics (age, education, occupation, area of living.)
7.
MATERIAL AND METHODS
7.1
Source of data
Data will be collected from the primigravid women attending ante-natal
clinic in a selected hospital udupi.
7.1.1
Research design
Pre experimental (one group pre-test post-test) design will be used for the
study.
7.1.2
Setting
The study will be undertaken in ante-natal clinic in a selected hospital
which is situated in udupi. This clinic provides ante-natal and postnatal care to all the
mothers. It helps in prevention of complication and promotion of health. The hospital
is thirty kms away from Mulki. It is 0nefifty bedded hospital. The approximate number
of outpatients fifty to seventy five per day and number of deliveries are eight per day.
7.1.3
Population
The population for this study include primigravid women who are pregnant
for the first time and within 20 weeks of gestation, attending ante-natal clinic in a
selected hospital udupi.
7.2
Method of collection of data
7.2.1
Sampling procedure
A convenient sampling technique will be used for the study.
7.2.2
Sample size
The study will be conducted among 40 primigravid women within 20
weeks of gestation, attending ante-natal clinic in a selected hospital udupi.
7.2.3

Inclusion criteria for sampling
Primigravid women within 20 weeks of gestation and pregnant for the first
time.

Primigravid women who are attending ante-natal clinic in a selected
hospital udupi.

Primigravid women who are able to understand and speak Kannada or
English.
7.2.4

7.2.5
Exclusion criteria for sampling
Participants who are in the health profession.
Instruments intended to be used
The tool developed for the study is structured interview schedule.
consists of 2 parts:

Part 1-baseline characteristics

Part2-structured interview schedule.
It
7.2.6

Data collection method
Data from the sample will be collected after obtaining prior permission
from the concerned authorities of the institutions.

The investigator will introduce herself to the participants.

The purpose of the study and method of data collection will be explained to
the participants and informed consent will be obtained.

Confidentiality will be assumed to the participants to get their cooperation.

On the first day pre-test knowledge will be assessed using interview
schedule followed by video assisted teaching program.

Post test will be conducted with the same interview schedule on seventh
day.
7.2.7

Data analysis plan
Collected data will be analyzed using descriptive (frequency, percentage,
mean, and standard deviation) and inferential (chi- square test and ‘t’ test)
statistics.

7.3
The data will be presented in the form of tables and graphs.
Does the study require any investigation to be conducted on patients
or other humans or animals? If so, please describe briefly.
Yes, the investigation needs to assess the knowledge of primigravid
women regarding high risk pregnancy and also to administer video assisted teaching
program after getting the informed consent from them.
7.4
Has ethical clearance been obtained from institutions in case of 7.3?
Yes. Ethical clearance is obtained from the concerned institution.
8.
LIST OF REFERENCES
1.
Park k. Park’s textbook of preventive and social medicine. 20th ed.
Jabalpur: M/S Banarsidas Bhanot Publishers; 2009.P. 447-51.
2.
Fraser DM, Cooper MA. Myles textbook for midwives. 14th ed.
Edinburgh: Churchill livingstone; 2003.
3.
May KA, Mahlmeister LR. Maternal and neonatal nursing-family centered
care. 3rd ed. Philadelphia: J.B Lippincott Pvt Ltd; 1997.
4.
Pilliteri A. Maternal and child health nursing. Care of child bearing and
child rearing family. 4th ed. Philadelphia; Lippincott company; 2003.
5.
Every pregnancy faces risk (WHD 98.5)[Internet]1998 Dec 01[Updated
Oct 10,2005;Cited 2006 Apr 6].
Available from: http://who.int/doctrine/worldhealthday/in/pages
6.
Morbidity and mortality of pregnancy. [online].
Available from: URL: http://www.ncbi.nlm. ncb.gov/ pubmed/ 8178896-
7.
Latha K. Nightingale nursing times. A window for health in action. Noida:
M/S Shree ram Enterprises; 2008 Jul; 7(4): 52-4.
8.
Nosseir SA, Mortada MM, Nofal LM, Dabbous NI, Ayoub AI Screening
of high risk pregnancy among mothers attending MCH centers in
Alexandria. J Egypt Public Health Assoc. 1990; 65 (5-6): 463-84.
Available from: http://www.ncbi.nlm.nih.gov/pubmed/2134086.
9.
James DK. High risk pregnancy. 2nd ed. Philadelphia: W.B. Saunders;
1999. P 9-11.
10.
Annemieke CC , Hens AA, Peter GJ, Chantal WP,
Brouwers et al.
Perinatal mortality and severe morbidity in low and high risk term
pregnancies. November 2010; 341(10).
Available from: http://www.bmj.com/
11.
Dutta
DC.
Textbook
of
Obstetrics
including
perinatology and
contraception. Newdelhi: New central book agency; 2007. p.631.
12.
Know your birth rights, National safe motherhood day, 2009.
Available from: url:http//www.pubmed.com
13.
Mubasher. High risk pregnancies in rural area.2006.
Available from: http://www.gfmer.ch/IAMANEH-ESMANEH-/pdf
14.
Samiya M, Samina M. Original paper identification of high risk
pregnancy by a scoring system and its correlation with perinatal outcome.
Indian journal for the practising doctor. Mar to Apr 2008; 5(1).
15.
N.D Jayshree, K.Malati. Prevalence of anaemia in pregnancy in semiurban area of Miraj. JMCH. 2003; 8(2): 48-51.
16.
Soltani MS. et al. Evaluation of mothers knowledge in pre and postnatal
preventive care in the Tunisian publique 1999 Jan; 11(22): 203-10.
9
Signature of the candidate
10
Remarks of the guide
11
Name and designation of
11.1 Guide
MRS. MALATHI KAMATH
ASST. PROFESSOR
DEPARTMENT OF OBSTETRICS AND
GYNAECOLOGICAL NURSING
ST. ANN’S COLLEGE OF NURSING
MULKI, MANGALORE
11.2 Signature
11.3 Co-Guide
MRS. MARIE. E. PINTO
PROFESSOR
DEPARTMENT OF OBSTETRICS AND
GYNAECOLOGICAL NURSING
ST. ANN’S COLLEGE OF NURSING
MULKI, MANGALORE
11.4 Signature
11.5 Head of the department
11.6 Signature
12
12.1 Remarks of the chairman and
principal
12.2 Signature
MRS. MARIE. E PINTO